Accountability vs Insurance Coverage: What Health Practitioners Need To Know

When seeking legal advice for complaints or referrals, it is important for health practitioners to understand the scope of their Professional Indemnity Insurance (PII). PII generally covers legal defence costs, assistance during investigations, and any damages or penalties that fall within the policy terms. However, most insurance policies contain clauses that prohibit practitioners from admitting liability without the consent of the insurer.¹ If a practitioner admits guilt or accepts fault without the insurer’s prior consent, the insurer may decline to provide cover for legal costs or indemnity.

This causes a degree of conflict as there are benefits in accepting responsibility as it demonstrates accountability to the investigating body and can mitigate the penalty being imposed by the Tribunal when facing disciplinary proceedings. This leaves the practitioner exposed to losing coverage for their legal fees.